Randall Steven Cory, DDS
Individual provider Active NPI General Practice Dentistry · Syracuse, IN
NPI 1447412705 · NPPES record last updated Jun 27, 2008
Key facts
- NPI
- 1447412705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12007293A (IN)
- Practice address
- 801 N Huntington St
Suite 11
Syracuse, IN 46567-1151 - Phone
- (574) 269-9681
- NPI assigned
- Jun 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007293A | IN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12007293A | IN | Yes |
Addresses
Primary practice location
801 N Huntington St
Suite 11
Syracuse, IN 46567-1151
Mailing address
2400 Winona Ave
Unit H
Winona Lake, IN 46590-2122
Phone (574) 269-9681
Other providers in Syracuse, IN
- Shane M. Bullick
- Diana Maureen Byron
- Jack Prow Clark
- Jodi S Clouse
- Olivia Cook
- Christopher Craig
- Dr Rod Kaufman, Optometrist, Inc.
- Chris Dykhuisen
- Dynamic Spine and Rehabilitation Center
- First Call MD LLC
All providers in Syracuse, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.